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What is hypoglycemia? Hypoglycemia (from other Greek - from below, under + - sweet + - blood) is an acute pathological condition in which the blood glucose level drops below 3.5 mmol / l, as a result of which hypoglycemia syndrome develops. It is one of the formidable complications of diabetes and is accompanied by various symptoms up to coma.
Hypoglycemia in type 2 and type 1 diabetes does not differ in symptoms. They occur more often in type 2 diabetes. Glycemia is the level of sugar in the blood. The norm is 60-100 mg or 3.3-5.5 mmol / l. This indicator is one of the most important controlled variables in living organisms (homeostasis). Diabetics are, in fact, patients with impaired glycemia. Diabetes- a very complex and serious disease, it often has many different acute and chronic complications.
One of the urgent acute conditions is hypoglycemia. Unlike ketoacidosis, hypoglycemia develops very quickly, within 30 minutes. At the same time, there is the clinical picture itself and there is a period of precursors (weakness, hand tremor, sweating, hunger).
Sometimes the stage of precursors or its initial signs is reduced and the patient loses consciousness immediately. Hypoglycemia and diabetes are not identical conditions, as some believe.
Hypoglycemic manifestations may develop in healthy people, for example, with strict diets with a low carbohydrate content, with sharp sudden physical activity, fasting. But more often the syndrome is noted in diabetics when receiving insulin (its excess).
Why can hypoglycemia develop?
If there is more insulin in the blood than is needed to absorb the incoming sugar, hypoglycemia develops. Thus, the mechanism of this syndrome is always the same: there is more insulin than glucose. This is possible when taking drugs that stimulate the work of beta cells that produce insulin.
These include sulfonylurea derivatives and ginides, which are popular with diabetics. They are safe enough, but constant stimulation of these cells leads to their depletion and atrophy. Then insulin therapy becomes necessary. Therefore, modern medicine tries to use these groups less often.
What happens during hypoglycemia? In the body, there is a sharp lack of carbohydrates, and they are a source of energy and nutrition for brain cells and muscles.
Internal organs and muscles are in a state of hunger, which can lead to irreversible consequences. Energy hunger leads to the release of contra-insular hormones into the blood - cortisol, adrenaline, glucagon.
With an increase in adrenaline, the first symptoms of hypoglycemia appear: pallor, weakness, sweating, heart palpitations, fear and anxiety.
Etiology of the phenomenon
Causes of hypoglycemia in diabetes mellitus:
- the doctor may make an incorrect dose calculation;
- a large dose of insulin may be administered - accidentally or intentionally for depression;
- the insulin pen for administering insulin is faulty;
- incorrect glucometer readings (its misalignment), when it shows higher blood sugar numbers that do not correspond to reality;
- instead of subcutaneous injection, the drug was mistakenly injected intramuscularly;
- when injecting drugs into the arm or leg, where physical activity is higher, or massage with cotton wool after injection, this leads to accelerated absorption of the drug and insulin can jump.
- also the reason may be the use of a new drug that is unfamiliar to the body;
- slow evacuation of insulin from the body due to renal or hepatic pathology; instead of "long" insulin, "short" insulin was accidentally introduced in the same dose.
Insulin sensitivity of the body increases when taking sleeping pills, aspirin, anticoagulants, antihistamines.
It also occurs during exercise elevated temperature environment, disorders of the level of hormones of the pituitary or adrenal glands, HB and pregnancy.
If the patient was prescribed sulfonylurea drugs, he lost weight on the diet and improved glucose uptake, but the dose of sulfonylurea remained the same, hypoglycemia will develop. The doctor must keep this in mind.
If the patient eats poorly or rarely eats, physical overstrain - with it, glycemia needs to be controlled 2 times more often so as not to miss the moment of decline.
Blood sugar should be measured before and after exercise. The appointment of sulfonylurea and drugs at the same time, which potentiate its action, the intake of alcohol - with it, hypoglycemia can develop already on the second day.
If it is unavoidable, it should only be taken with a glucose-containing snack. In addition, alcohol first sharply reduces blood sugar, the patient eats carbohydrates. Then, decomposing in the liver, it turns into carbohydrates, which further increase sugar. Therefore, the patient gets hyperglycemia!
An overdose of insulin, the patient did not eat the prescribed amount of carbohydrates (bread units) after taking a sugar-reducing drug. When calculating a diet, the doctor always calculates the amount of XE you need to eat for breakfast, lunch, dinner and snacks. 1 XE = 14 grams of carbohydrates.
The reason may be in malabsorption - due to a lack of digestive enzymes, the body absorbs little nutrients.
Low carbohydrate diet, fasting. With neuropathy, SD lingers in the stomach for a long time and it is slowly emptied. Rapid insulin administration and delayed food intake.
Symptomatic manifestations
Each person has a different level of glycemia in the norm. With a decrease in the level from the usual by 0.6 mmol / l, it already gives hypoglycemia. Carbohydrate deficiency is initially manifested by a slight but growing feeling of hunger.
Other symptoms of hypoglycemia are added:
- profuse sweating, skin turns pale;
- feeling of acute hunger;
- tachycardia and convulsions;
- nausea;
- aggressiveness;
- pathological fear and anxiety;
- decreased attention; general weakness.
When glucose falls to the level of hypoglycemia, tremors appear in the hands and in the body; the head is spinning and aching, vision is weakened, speech and coordination are disturbed.
Symptoms of hypoglycemia in diabetes may not appear all at once. Diabetics often have 2-4 symptoms, which he knows well and says that he is “shaking”.
Those who often have blood sugar jumps may not feel their hypoglycemia - it is not bright in him. The same happens to the elderly. There may be only a slight malaise. Diabetics, attentive to themselves, have time to notice signs of hypoglycemia in time and take glucose.
Diabetics with a tendency to hypoglycemia should not work in transport. This is because hypoglycemia distracts attention and such a person behind the wheel can commit a traffic violation or have an accident.
Especially dangerous is the development of hypoglycemia syndrome during sleep. In these cases, breathing becomes uneven, sleep is restless, the skin becomes cold, especially on the neck; sweat comes out. In these cases, the doctor should review the diet and reduce the evening dose of insulin.
Diabetes mellitus and signs of hypoglycemia:
- hypoglycemia will manifest itself in a feeling of sudden hunger;
- mood changes and anxiety;
- weaknesses;
- hyperhidrosis;
- deterioration in the clarity of vision;
- pallor of the face;
- trembling in the hands;
- drowsiness and cephalalgia;
- tachycardia.
First aid for hypoglycemia
With the appearance of symptoms of a decrease in hycemia, i.e. hypoglycemia, it is important to immediately measure the level of sugar. If the level is less than 4 mmol / l, you need to urgently eat simple (fast) carbohydrates with a high GI (glycemic index). For example, a glass of juice (200 ml) is 2 XE. If there is no juice, eat 4-5 pieces of sugar and drink warm water, then the body will absorb them faster.
At such moments, sweet sodas are welcome; they are rapidly absorbed due to gases. If a person is weak and cannot swallow, smear the mouth or tongue with jam or jam.
After a few minutes, the person's condition usually improves. Then you can ask what caused the hypoglycemia and what the sugar level was before the attack. 15 minutes after eating, measure the sugar level again.
severe hypoglycemia
At the same time, a patient with hypoglycemia cannot help himself. Then you need to make sure that others understand that you are a diabetic. From America came the fashion for tattoos with the inscription "I am a diabetic"; wearing bracelets with an engraving and an inscription about diabetes.
If a diabetic's liver is healthy, it will correct hypoglycemia itself: in the absence of carbohydrate intake for 30 minutes, the liver releases its glycogen into the blood with a powerful jerk - this is a hormone that dramatically increases blood glucose - up to 15 mmol / l.
It's not scary; it will go down by itself during the day. But if the liver is sick, the patient falls into a coma and loses consciousness. Then you need to give the patient a drink of warm sugar syrup - in a tube or cook it yourself.
Also, under the tongue, you can put candy, refined sugar, tableted glucose - 3-4. After 15 minutes, be sure to measure your blood sugar again. During this time, call the joint venture.
Consequences of hypoglycemia
Hypoglycemia is considered a medical emergency precisely because of its consequences. The most harmless of them - headache, which after eating will pass by itself. Cephalgia is directly proportional to the degree of hypoglycemia. If the pain is severe, an analgesic may also be needed.
With a deficiency of glucose, which is the food for the brain, its cells become necrotic. If hypoglycemia increases, it leads to hypoglycemic coma. You can't fix it just by eating. Urgent hospitalization is required.
A coma can last several minutes or even days - everything is determined by the body's reserves. If the coma is the first, the body recovers quickly; if not, the body is thrown farther each time, the damage to vital organs is greater and the body recovers longer.
And another terrible consequence - hemorrhage in the brain. It proceeds in the clinic individually, which depends on the experience of diabetes and the age of the patient.
Acute hypoglycemia can also exacerbate existing chronic diseases of the cardiovascular system, hypertension, atherosclerosis and cause acute renal failure, hypertensive crisis, etc. This is especially dangerous in elderly patients.
Harbingers of coma:
- poor concentration of attention;
- impaired speech; impaired coordination of movements;
- sudden deterioration in vision;
- convulsions and loss of consciousness.
Breathing slows down and all reflexes gradually disappear. The patient should be immediately hospitalized. Sugar in a coma drops to 1.7 mmol / l or less.
Note to diabetics
In order to prevent the development of coma, a diabetic should always have with him not only a glucometer, but a bag of refined sugar or sweets. For measurement, it is advisable to use your own glucometer, because the readings can be different.
There is no such thing as excessive sugar control. It is impossible to ignore not only high, but also low indicators.
In people with hypertension or CVD, the appearance of symptoms of nausea, dizziness, headache, weakness can be mistaken for an increase in blood pressure. For a diabetic with CVD, this can be perceived as an attack of hypertension, and such patients urgently begin to take pills to lower blood pressure and thereby worsen their condition.
Thus, another danger of hypoglycemia is that patients are little informed about it. Hypoglycemia can cause MI and strokes in the hearts.
Glucose deficiency in children can be fatal. They have no internal reserves. Such children with DM should be constantly monitored by an endocrinologist and an immunologist.
With reduced immunity and weakening of the body, hypoglycemia can cause a malfunction of the central nervous system, which can lead to the onset of dementia, impaired adaptation and mental disorders.
When to measure blood sugar
Sugar should be measured before and after meals, on an empty stomach in the morning, before going to bed, with sudden physical exertion, while traveling, after stress, during pregnancy, before driving; during other illnesses. Only under these conditions it is possible to adjust the treatment and the patient's menu.
First aid for the onset of a coma with loss of consciousness
Recommended: insert a spatula or spoon between the teeth so that there is no bite of the tongue during convulsions, turn the patient's head to one side so that he does not choke on vomiting or saliva. You can not try to drink or feed the patient in an unconscious state, he needs to inject glucose and call an ambulance.
Prevention of complications
The main and, perhaps, one principle of avoiding complications is to regularly measure blood sugar levels. At the very beginning of hypoglycemia, you can drink glucose tablets, you can simply put it in your mouth, it is easily absorbed in your mouth. It will enter the bloodstream in a few minutes and calculating its dose is quite simple: you need to note how much 1 tablet raises your sugar level. After taking it, measure sugar after 40-45 minutes. If there are no glucose tablets, 2-3 pieces of refined sugar will replace them.
Some diabetics try to eat according to the principle “you can’t spoil porridge with butter” - at the same time take slow and fast carbohydrates: they eat sweet and starchy foods, drink sweet soda, juices. Then there is a risk of earning hyperglycemia and causing the onset of diabetic hyperglycemic coma. An increased intake of "slow" carbohydrates will cause a sharp rise in sugar after a few hours.
When first confronted with such a phenomenon as hypoglycemia, it is difficult to establish an accurate diagnosis.
The patient is simply not able to correctly interpret and consult with a specialist in the field of medicine in time.
How little we are enlightened in this area!
Why do diabetics need to carry glucose or refined sugar tablets with them?
Let's see what this complication is.
hypoglycemia- a pathological condition of a person, upon the onset of which the level of sugar in the bloodstream quickly decreases, and, as a result, its low assimilation by cells of the tissues of internal organs (brain cells especially suffer, experiencing energy hunger).
Due to the lack of emergency compensation of glucose in the body, it can lead to very serious consequences.
ICD-10 code ( International classification diseases) in hypoglycemia in diabetes mellitus E 15, E 16.
This complication has two forms: true and false.
True- one of the most common types of lowering the sugar content in the body, provoked by a supersaturation of carbohydrates in the body. It is caused by increased secretion of insulin, which lowers blood glucose levels. Most often, this species occurs in people who are overweight or in diabetics with an insulin-independent form of the disease.
False- a type of pathology in which sugar levels are both normal and elevated. Occurs when there is a severe drop in blood sugar. There is a risk of development, for example, during intense sports or strong physical exertion.
Very often people confuse two concepts: hypoglycemia and hyperglycemia.
Let's figure it out:
hyperglycemia - clinical symptom corresponding to elevated blood sugar levels. It manifests itself in people with diabetes mellitus or other types of endocrine diseases.
Hyperglycemia can be caused by:
- low levels of insulin in the bloodstream;
- eating plenty of food containing simple and complex carbohydrates;
- stress;
- physical exercise;
- infectious, chronic diseases.
Coma state
A very common and important question remains: Why does hypoglycemia quickly develop into coma?
The main blow, as already mentioned, is taken by the cells of our brain.
A coma occurs due to a rapid decrease in blood glucose levels.
The reasons for the rapid development of hypoglycemic coma can be:
- a long period of use of one type of drug (addiction occurs);
- receiving large doses of insulin;
- violation of the diet;
- depression and stress;
- excessive secretion of insulin by the body;
- kidney failure;
- physical exercise;
- drinking a large dose of alcohol, without snacks.
Causes
Since the complication also affects a healthy person, diabetics should be especially careful.
The main causes of hypoglycemia with and 2 types - the use of a different dose of insulin with food restriction, stress, excessive physical activity, increased mental work,.
A complication is dangerous because it leads to various negative consequences for the body, such as:
Important!
In medical practice, there have been cases when a complication led to disability or provoked the death of a patient.
Consequences for the body
Sometimes, the consequences of the transferred syndrome manifest themselves in the form of a sharp deterioration in vision, and starvation of brain cells can cause a heart attack or stroke.
In the case of a rapid decrease in the concentration of sugar in the blood stream, the brain cells experience severe starvation, which to a state of hypoglycemic coma.
Before losing consciousness, patients develop hallucinations, high blood pressure, convulsions, heavy sweating, and salivation.
Note to those with diabetes
There are things that every diabetic needs to know. With a mild degree, a person can help himself on his own, by taking 15-20 gr. fast carbohydrates. For example:
- 2.3 pieces of refined sugar or sticks of sugar;
- sweet water;
- glucose tablet (sold in a pharmacy).
Symptoms
They should recognize not only the sick, but also people from the environment in order to provide timely assistance if such a need arises.
The most common signs include:
- strong feeling of hunger;
- increased weakness;
- heavy sweating;
- tremor;
- cardiopalmus;
- decreased vision (blurring of objects in the field of view);
- dizziness;
- nervousness, agitation, aggression.
Diagnostics
All diagnostic procedures are carried out exclusively by a doctor, all conclusions are made by analyzing blood parameters.
Usually, the glucose level is determined, if it is lower than usual, then additional studies are carried out.
The reasons for the difficulties in establishing a diagnosis can be the presence of a large number of diseases with similar symptoms.
You also need to analyze conditions for hypoglycemia.
Some develop symptoms when there is not enough food to eat (fasting), others after eating, especially if the food is high in carbohydrates.
To establish a diagnosis, you need to find a connection between the manifestation of symptoms and very low blood counts, and also make sure that the symptoms disappear when the sugar content rises.
Classification
Depending on the level of manifestation of symptoms, the characteristics of occurrence, etc. distinguish the following types of hypoglycemia:
Neonatal (transient) occurs in newborns during the first day of life due to the lack of secretion of their own glucose by the body.
functional- occurs in women during lactation.
Alimentary- develops with a disorder in the absorption of glucose from the food taken (occurs after operations associated with the gastrointestinal tract).
Alcoholic is a consequence of alcoholism. Severe hypoglycemia syndrome can be observed in non-insulin dependent patients when taking alcoholic beverages.
idiopathic is rare. It is characterized by increased production of insulin by the pancreas and a decrease in glucose secretion by the liver.
If hypoglycemia occurs in children!
Complication bears great danger for newborns, as cases of death are known.
What to do if your child is diagnosed with hypoglycemia:
- taking or injecting sterile ten percent glucose (intravenously), with loss of consciousness, or with frequent convulsions, only under the supervision of a doctor;
- compliance with a carbohydrate diet;
- older children should have sweets, chocolate, fruits with them.
Prevention
Patients who know that they have a high percentage of encounters with this complication should observe the following rules:
- Accurate calculation of the dose of insulin;
- Compliance with the diet, a clear intake of insulin;
- Use of a glucometer;
- Exclusion of alcohol;
- Avoid infectious diseases whenever possible.
Useful video
This is detailed in the video:
Marina Pozdeeva on the selection of hypoglycemic therapy
Marina Pozdeeva
General information: what is glycemia in diabetes
Type 2 diabetes is characterized by a constant deterioration in beta-cell function, so treatment should be dynamic, involving a gradual increase in drug intervention as the disease progresses. Ideally, blood glucose levels should be maintained within close to normal limits: before meals, blood glucose mmol/l and glycated hemoglobin (HbA1c) less than 7%. However, hypoglycemic therapy alone does not provide adequate treatment for patients with type 2 diabetes. Lipid and blood pressure monitoring is essential.
Aggressive glucose lowering - not best strategy for a wide range of patients. So, in patients with high risk cardiovascular disease, lowering HbA1c levels to 6% or less may increase the risk of cardiovascular disease.
Therapy for type 2 diabetes should be based on individual risk stratification. Research by a group of scientists led by Frida Morrison, published in the Archives of Internal Medicine, 2011, showed that in patients who visit an endocrinologist every two weeks, blood glucose, HbAc1 and LDL levels fall faster and are better controlled than in patients who apply a visit to the doctor once a month or less. A significant contribution to the success of the treatment is made by the patient himself, following the diet and lifestyle recommendations.
Pharmacotherapy for type 2 diabetes
Early initiation of pharmacotherapy for type 2 diabetes improves glycemic control and reduces the likelihood of long-term complications. As for the question of how to treat type 2 diabetes and which drugs to use, everything will depend on the chosen treatment regimen.
Type 2 diabetes mellitus (T2DM) is characterized by hyperglycemia resulting from a combination of disorders, including:
- tissue insulin resistance;
- insufficient secretion of insulin;
- excessive or inadequate secretion of glucagon.
Metformin
Metformin is the drug of choice for monotherapy, as well as the leading combination treatment for type 2 diabetes mellitus. Its benefits include:
- efficiency;
- no weight gain;
- low chance of hypoglycemia;
- low level of side effects;
- good tolerance;
- low cost.
Scheme 1. List of hypoglycemic drugs used in type 2 diabetes
The dose of metformin is titrated over 1-2 months, determining the most effective method selection. The therapeutically active dosage is at least 2000 mg of metformin per day. To reduce risk side effects from the side gastrointestinal tract the drug is taken during or after meals several times a day.
Metformin reduces the risk of developing dementia associated with type 2 diabetes. This was proven in a large 2013 study involving 14,891 patients, divided into four groups depending on which drug they were taking. Throughout the experiment, patients received monotherapy with metformin, sulfonylurea drugs, thiazolidinediones, and insulins. Within five years after the start of treatment with metformin, dementia was diagnosed in 1487 (9 %) patients. This is 20% lower than the sulfonylurea group and 23% lower than the thiazolidinedione group (data from Colayco DC, et al., Diabetes Care, 2011).
Two-component treatment regimen
If within 2-3 months of monotherapy with metformin it was not possible to achieve a stable decrease in blood glucose levels, another drug should be added. The choice must be based on individual characteristics patient. According to the recommendations of the American Association of Clinical Endocrinologists, published in the journal Endocrine Practice in 2009, it is better to give preference to:
- DPP-4 inhibitors - when raising glucose levels and on an empty stomach, and after eating;
- GLP-1 receptor agonists - with a significant increase in blood glucose after meals;
- thiazolidinedionam - in the treatment of patients with metabolic syndrome and / or non-alcoholic fatty hepatosis.
Withdrawal of oral medications and insulin monotherapy in type 2 diabetes is associated with weight gain and hypoglycemia, while combination treatment reduces these risks.
Table 1. Groups of drugs used in type 2 diabetes
Table 2. List of drugs (tablets, solutions) used in type 2 diabetes
Triple therapy for type 2 diabetes
With the ineffectiveness of two-component therapy for 2-3 months, the addition of another, third hypoglycemic drug is undertaken. It could be:
- an oral drug belonging to a different class of hypoglycemic agents than the first two components of the treatment regimen;
- insulin;
- injectable exenatide. Thiazolidinedione drugs are not recommended as a third agent in the regimen. Thus, data from the American Association of Endocrinologists indicate an increased risk of myocardial infarction in patients taking roxiglitazone. Therefore, it is recommended to prescribe it only to those patients who cannot control their glucose levels with other drugs.
In patients at high risk for CVD, lowering HbA1c to 6% or less may increase the risk of CVD. Thus, observation of a group of 44,628 patients, conducted by American scientists led by Danielle C. Colayco, showed that in patients with an HbA1c level of less than 6%, cardiovascular problems were observed 20% more often than in patients with an average HbA1c level 6–8 %.
Published in Diabetes Care, 2011An experiment conducted by the ACCORD (Action to Control Cardiovascular Risk in Diabetes) research group showed that a drop in HbAc1 levels below 6% in risk patients led to an increase in five-year mortality from myocardial infarction.
Data from researchers led by Gerstein HC, published in The new England journal of medicine, 2011
Another well-known thiazolidinedione, pioglitazone, has also been reported to be associated with an increased risk of cancer. Bladder against the background of the reception. American Control Association medicines The FDA does not recommend the use of pioglitazone in patients with a history of bladder cancer.
GLP1 receptor agonists have a different mechanism of action than other hypoglycemic drugs. They mimic endogenous incretin GLP-1 and thus stimulate glucose-dependent insulin release. In addition, GLP1 receptor agonists help reduce glucagon levels.
The combination of exenatide, the most well-known drug of this group, with one or two oral (for example, metformin and / or sulfonylurea drugs) attracts with its simplicity and high efficiency.
Insulin as a supplement
Many patients with type 2 diabetes who cannot be controlled with oral hypoglycemic agents require insulin therapy. The combination of oral sugar-lowering drugs and insulin in type 2 diabetes effectively lowers blood glucose levels.
It is advisable to add a single morning insulin injection of medium or long duration to oral hypoglycemic agents. This approach may provide better glycemic control with lower doses of insulin.
A group of British scientists led by Nicholas A. Wright (Nicholas A Wright) in the course of a six-year randomized study proved that the abolition of oral drugs and insulin monotherapy in type 2 diabetes is associated with the likelihood of weight gain and hypoglycemia, while combination treatment reduces these risks. Experimental data published in Internal Medicine in 1998.
Insulin can be used in people with severe hyperglycemia, as well as temporarily during a period of general illness, pregnancy, stress, medical procedure or surgery. As type 2 diabetes progresses, the need for insulin increases and additional doses of basal insulin (intermediate and long-acting) and bolus insulin (short- or fast-acting) may be needed.
When deciding with which oral hypoglycemic agents it is better to combine insulin, one should be guided by general principles building a multicomponent treatment regimen for type 2 diabetes. It is known, for example, that the addition of insulin at bedtime during treatment with metformin leads to weight gain half as often as combined treatment with insulin and sulfonylurea drugs or double insulin monotherapy (data from H. Yki-Järvinen L. Ryysy K. Nikkilä, Internal Medicine, 1999).
During treatment with bolus insulin, it is necessary to stop oral drugs that enhance insulin secretion (sulfonylureas and meglitinides). In this case, metformin therapy should be continued.
Hypoglycemia is a low blood sugar level. This condition can progress and lead to serious consequences: irreparable brain damage and death. According to official medicine, hypoglycemia lowers glucose to 2.8 mmol / l when a person feels obvious discomfort, or to 2.2 mmol / l when the patient does not feel any symptoms. More often seizures occur in type 2 diabetes.
Reasons for development
The mechanism of this disease state is the same: there is more insulin than glucose. The body begins to lack carbohydrates, which provide energy. Muscles, internal organs feel "hunger", and if measures are not taken in time, the consequences can be severe and even fatal.
Causes varied.
Many cases of hypoglycemia are not associated with medications or chronic diseases, but with dietary disorders and nutritional problems.
- Malabsorption syndrome. This is a poor absorption of nutrients by the body due to a lack of digestive enzymes.
- Irregular meals or forced skipping of the next snack.
- An unbalanced diet that is low in carbohydrates.
- Unexpected heavy physical activity, before or immediately after which it was not possible to take glucose.
- Alcohol consumption.
- Desire to lose weight with a very strict diet or no food at all. At the same time, the diabetic does not reduce the dose of insulin and other medications.
- Very slow gastric emptying and absorption of food as a result of diabetic neuropathy.
- Use of rapid insulin before meals and food delay.
Patients with diabetes 2 swamps for normal health should not feel at all severe attacks hunger is the first sign of low blood sugar. Therefore, changes in diet and treatment should be treated carefully.
Symptoms and signs
When taking hypoglycemic drugs, it must be borne in mind that each patient has his own normal level of glycemia. A significant drawback of sugar is considered to be a decrease of 0.6 mmol / l from the usual individual indicator. Optimally, the indicators should coincide with those observed in a healthy person. But in some situations diabetics have to artificially induce hyperglycemia for a certain time.
Signs of a lack of carbohydrates begin to appear in a mild form and become more pronounced over time.
The first symptom is a feeling of hunger. Also with hypoglycemia observed:
- pallor
- profuse sweating
- acute hunger
- palpitations and convulsions
- impaired attention and concentration
- aggressiveness, anxiety
- nausea
When glycemic levels drop to dangerous levels, you may experience:
- weakness
- dizziness and severe headache
- speech disorders, vision problems
- feeling of fear
- movement coordination disorder
- convulsions, loss of consciousness
Symptoms may not appear at the same time and not all. In some cases, those who often have jumps in glycemia, who have had diabetes for a long time, the elderly, may not feel them at all or feel a little unwell.
Some diabetics manage to determine in time that the glycemia is lower than usual, measure the sugar level and take glucose. And others abruptly lose consciousness and may receive additional injuries. People with diabetes who are prone to hypoglycemia forbidden to drive vehicle or doing work that affects other people's lives. Taking certain medications can also make it difficult to identify the problem.
In some cases, patients with such symptoms may behave inappropriately, be confident that their health is in order until the moment of loss of consciousness. On advice to take pills, an aggressive reaction is possible or, on the contrary, an attack of weakness, drowsiness, lethargy.
Particular attention should be paid to patients with diabetes, in whom hypoglycemia occurs during sleep. In such cases, sleep is restless, breathing is interrupted and confused, the skin is cold, especially in the neck, and the body is covered with profuse sweat. In children in such cases, it is desirable to measure glycemia at night and reduce the evening dose of insulin or revise the diet. In newborns, after the end of breastfeeding, it is necessary to immediately develop the habit of a low-carbohydrate diet.
Treatment and prevention of complications
The only way to avoid complications is constantly monitor the level of sugar. If you feel hungry, measure your sugar and take steps to stop the attack. If there are no symptoms, but it is clear that there was no timely snack or physical activity, take glucose tablets to prevent problems. She acts quickly and predictably. Calculating the dose is quite simple, it enters the blood in a few minutes. After 40-45 minutes, you need to measure the level of sugar and, if necessary, repeat to eat a few more "glucoses".
Some diabetics in such cases prefer to eat starchy foods, sweets, fruits, drink fruit juices or sugary sodas. This can provoke an attack of hyperglycemia, since these products contain not only "fast", but also "slow" carbohydrates. They are absorbed more slowly, because. digestive system should take the time to process them. An abundance of "slow" carbohydrates a few hours after eating will cause a sharp jump in sugar. Glucose in combination with water is absorbed instantly from the oral cavity. It doesn't even have to be swallowed.
It can be easily determined how many glucose tablets increase glycemia. With products, this is more difficult. With a fright or in a somewhat inadequate state, there is a risk of overeating and further harming health.
If it is not possible to buy glucose, you can carry pieces of refined sugar with you and take 2-3 cubes to prevent hypoglycemia.
First aid for hypoglycemia
If the diabetic is no longer in control of the situation and cannot take action, the help of others will be needed.
Usually the patient is weak, lethargic and almost unconscious. He will not be able to chew something sweet or eat a pill, there is a risk of choking. It is better to give a sweet drink, such as warm tea with sugar, or a glucose solution. There are special gels that can lubricate the oral cavity and tongue. They can be replaced with honey or jam. Patients should be monitored during an attack. When your measures work, and he can answer questions, you will need to urgently apply a glucometer and find out how much more glucose is needed to normal and what caused the discomfort.
The cause of this condition can be not only hypoglycemia, but also a heart attack or pain in the kidneys, a jump blood pressure so you have to be very careful.
- stick a wooden stick in the teeth so that the patient does not bite his tongue during convulsions
- turn his head to one side so that he does not choke on saliva or vomit
- give an injection of glucose, in no case try to drink or feed
- call an ambulance
Possible consequences of hypoglycemia
As a result of such attacks, there is a risk of worsening the state of health.
With hypoglycemia from a lack of energy m The brain and cardiovascular system can be irreparably damaged.
The wrong way out of the state causes a jump in sugar and a new deterioration in health, a jump in hypertension, a heart attack, kidney failure.
Loss of consciousness can cause serious injury. Any imbalance in blood sugar will adversely affect overall well-being.
Diabetes mellitus is a disease that entails the development of various complications, many of which can pose a serious danger to the life and health of the patient. These conditions can be acute or chronic.
One of the acute and urgent complications is hypoglycemia in type 2 diabetes mellitus. It manifests itself in the form of a sharp decrease in blood sugar and, unlike ketoacidosis, develops rapidly, within half an hour. Sometimes the period of precursors (feeling of hunger, weakness, sweating) is reduced, in which case the person immediately loses consciousness.
Some mistakenly believe that hypoglycemia is diabetes mellitus, but this is not entirely true. Sometimes it develops in perfectly healthy people for a number of reasons.
Hypoglycemia without diabetes can be observed with increased physical exertion, strict diets or fasting, and the absence of glucose-containing foods on the menu.
Most often, a similar attack in diabetes mellitus occurs when the patient receives insulin. Therefore, hypoglycemic coma becomes a frequent occurrence in type 1 diabetes.
A feature of non-insulin-dependent diabetes is that at the first stage of the disease it is well compensated with the help of physical activity, a properly selected diet, and sometimes taking hypoglycemic drugs. But with prolonged decompensation of the disease, the process of insulin production is reduced or stops altogether, so the patient switches to replacement therapy. In order to understand in which cases hypoglycemia can develop in this type of diabetes, one should remember the mechanism of its occurrence.
Why does hypoglycemia develop?
In a disease such as diabetes, hypoglycemia develops as a result of an excess of insulin, which is present in the blood in greater quantities than is necessary for the absorption of sugar.
The use of certain drugs for the treatment of type 2 diabetes, the meaning of which is to stimulate the production of insulin by beta cells. This is how sulfonylurea derivatives work. These are popular all over the world means that many patients take. They are quite safe and effective, but it is their effect that can cause a condition such as hypoglycemia in diabetes mellitus of this type.
In addition, with constant stimulation, insulin-producing cells are gradually depleted and undergo atrophic changes. As a result, the patient becomes in need of insulin treatment.
Symptoms of hypoglycemia
The symptoms of a hypoglycemic attack of diabetes are quite characteristic. It is important to be able to recognize them in time, because in the absence of help, paralysis of vital organs can occur.
All the symptoms of this condition are based on the fact that during this period the brain begins to experience energy hunger, and contrainsular hormones begin to be released in the body.
Mild hypoglycemia
The initial signs of hypoglycemia in type 2 diabetes are as follows:
Increased sweating begins;
Tremor develops;
The skin becomes pale;
tachycardia begins.
Such symptoms develop as a result of the activation of the mechanisms of inhibition of insulin secretion, and with a lack of nutrition in the central nervous system, it is noted:
Irritability and mood changes;
A sudden feeling of hunger;
Fatigue, weakness;
dizziness and pain in the head;
visual disturbances;
Feeling of "goosebumps";
Weakness in the legs.
It's no secret that glucose is used for energy. It is necessary for the normal functioning of all organs and systems. And for this reason, a decrease in sugar levels below 4 - 3.3 mmol / l is considered dangerous, to which it reacts human body. He directs all efforts to compensate for the lack of sugar in the blood.
Its reserves are in the form of glycogen, which is deposited in the liver. For its conversion into glucose, certain substances are needed - hormones. They are called contra-insular, because their action is diametrically opposed to insulin. These are cortisol, glucagon, adrenaline. It is the release of adrenaline in a condition such as a hypoglycemic attack of diabetes mellitus that gives symptoms in the form of irritability, anxiety, feelings of fear, blanching of the skin, tachycardia. It also determines sweating in diabetes. All this happens at the very beginning of the development of a hypoglycemic state.
In addition, the energy hunger of brain cells causes nervousness, increased appetite, blurred vision, weakness in the legs.
severe hypoglycemia
If a person does not receive the necessary portion of glucose during such a period, then when it drops to a level of 1.7 mmol / l, a coma quickly develops, accompanied by such disorders that can become irreversible and incompatible with life:
Violated attention, vision, coordination;
There is a strong change in behavior, the person becomes aggressive;
Consciousness is lost;
There are convulsions;
Perhaps the development of a vascular catastrophe (stroke).
It should be noted that a hypoglycemic attack in diabetes mellitus manifests symptoms in different ways, and there are individual signs of this pathology in each patient.
The main reasons for the development
The causes of hypoglycemia in type 2 diabetes can be very different:
1. The use of sulfonylurea drugs in newly developed diabetes. The patient, while dieting and reducing body weight, improves the absorption of glucose by the body. If he continues to use medicines in the same dosage as before, it will lead to a decrease in blood sugar. In such a situation, a competent doctor can cancel or reduce the dosage of the tablets taken.
2. The use of hypoglycemic agents requires compliance with a normal diet, so if the patient skips meals or eats poorly, this also leads to a decrease in blood sugar levels.
3. Symptoms of hypoglycemia in type 2 diabetes can occur if a person experiences physical overstrain, in which case glucose is consumed faster.
4. Hypoglycemic agents are excreted mainly by the kidneys. With the development of insufficiency of these organs, the concentration of the active substance may increase and hypoglycemia develops.
5. There are a number of drugs that can potentiate the action of sulfonylurea derivatives, or smooth out the primary manifestations of glucose decline. For this reason, the doctor prescribes funds taking into account their interaction.
6. Alcoholic drinks tend to reduce. Therefore, alcohol should not be drunk on an empty stomach. It is recommended to take it in small doses only during meals, or immediately after. As a snack, there should be dishes containing glucose.
What to do if there are signs of hypoglycemia
Attacks in diabetes associated with a decrease in blood glucose can be stopped with:
Foods containing simple carbohydrates; 
A few pieces of sugar or candy;
3-4 tablets of glucose.
After that, you must wait about 15 minutes, and if there is no improvement in the condition, repeat the reception again. If symptoms worsen, you should seek medical attention.
Since this disease mainly affects the elderly, the signs of hypoglycemia in type 2 diabetes can be smoothed out and disguised as pressure surges, vasospasms and other pathological processes. In order not to miss the development of this, you should constantly monitor your blood sugar level with a glucometer, and use it at the slightest sign of trouble.
